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Body Art Inspece Report Date: <br /> San Joaquin County Environmental Health Department Program p <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 5 Q Q 7 3S 8� <br /> \ (209)468-3420 <br /> 4'••••:••••i�` www.siogv.org/ehd Program <br /> C Fpa Element: <br /> Facility Name Address City Zip Code <br /> Mudville Tat2 Studio 127 w.harding way#B Stockton 95204 <br /> Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Gustavo Hurtado Final/Routine <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). <br /> V=Violation C=Corrected On Site <br /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION(cont.) C <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test I etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2. sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ [_1 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> � 5' ❑ Chemical used: Madacide <br /> appropriately <br /> 6. <br /> ro riatel <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• El El25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled,used,and disposed of <br /> ❑ 7• ap ropriatel El Wet contact time provided: 3 mins <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8. El 26. Barriers used Elsterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27. asepticallyE] <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments, needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, 30Cross-contamination avoided during all phases of <br /> ❑ 11. warm water ❑ ' procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathie Montie ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces, including chairs,armrests,etc.in <br /> ❑ 14. used ❑ ❑ 33. ood repair <br /> El <br /> CUSTOMERSICLIENTS ❑ 34. Permit/registration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. El El 35. Operation and employee training records present <br /> procedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form El® 18. and questionnaire <br /> ❑ E] 37. Permits obtained and available <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Gustavo Hurtado Received b (Signature): Phone:(209)546-2739 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion onlabout: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />